内镜下乳头括约肌小切开联合气囊扩张术治疗胆总管结石的临床应用

发布时间：2018-03-24 06:00

本文选题：胆总管结石　切入点：乳头肌切开术　出处：《皖南医学院》2017年硕士论文

【摘要】：目的:探讨内镜下乳头括约肌小切开联合气囊扩张术对胆总管结石的治疗效果。方法:回顾性分析2014.02至2016.11在池州市人民医院内镜中心行ERCP取石者71例,其中内镜下乳头肌小切开联合气囊扩张胆总管取石患者26例,内镜下乳头括约肌切开取石患者45例,两组资料具有可比性,对比分析两组疗效:?一次性结石清除率,?术后近期并发症。结果:1.一次性取石成功率:内镜下乳头肌小切开联合气囊扩张组为96.2%,单纯乳头肌切开组为97.8%,两组对比差异无统计学意义(p0.05)。2.近期并发症:(1)出血:内镜下乳头肌小切开联合气囊扩张组3.8%,单纯乳头肌切开组发生率为0,两组比较(P0.05)无统计学意义;(2)穿孔:两组均无穿孔病例;(3)术后胰腺炎:内镜下乳头肌小切开联合气囊扩张组为3.8%,单纯乳头肌切开组为8.8%,两组对比无显著差异(P0.05)。3.所取结石直径(cm):内镜下乳头肌小切开联合气囊扩张组为1.41±0.69,单纯乳头肌切开组为0.70±0.35,两组对比有显著差异(P0.05)。结论:内镜下乳头括约肌小切开联合气囊扩张组与乳头括约肌切开组早期并发症及一次性取石成功率基本相当,但内镜下乳头括约肌小切开联合气囊扩张术取石直径明显大于乳头括约肌切开组。故内镜下乳头肌小切开联合气囊扩张术对于治疗较大胆总管结石者取石更为安全。
[Abstract]:Objective: to investigate the effect of endoscopic sphincterotomy combined with balloon dilatation in the treatment of choledocholithiasis. Methods: 71 cases of choledocholithiasis treated with ERCP from 2014.02 to 2016.11 in the endoscopic center of Chizhou people's Hospital were analyzed retrospectively. Endoscopic papillary muscle incision combined with balloon dilatation choledocholithiasis in 26 patients, endoscopic sphincterotomy in 45 patients with lithotomy, the two groups of comparable data, the two groups of comparative analysis of the efficacy of two groups? One-time stone removal rate? Results 1. The success rate of one-off lithotomy: 96. 2 in endoscopic papillary myotomy combined with balloon dilatation group and 97. 8 in simple papillary myotomy group. There was no significant difference between the two groups (P < 0. 05, P < 0. 05, P < 0. 01). Endoscopic papillary myotomy combined with balloon dilatation group 3.8%, simple papillary muscle incision group 0, the two groups compared with P0.05) no statistically significant perforation: both groups without perforation cases / 3) postoperative pancreatitis: endoscopic papillary myotomy combined with small incision. There was no significant difference between the two groups in the diameter of calculi: 1.41 卤0.69 in endoscopic papillary muscle incision combined with balloon dilatation group, 0.70 卤0.35 in simple papillary myotomy group, and there was significant difference between the two groups. Conclusion: the early complications of endoscopic sphincterotomy combined with balloon dilatation group are similar to those of sphincterotomy group, and the success rate of one-off lithotomy is similar to that of endoscopic sphincterotomy group. But endoscopic sphincterotomy combined with balloon dilatation was significantly larger than that in the papillary sphincterotomy group, so endoscopic papillary sphincterotomy combined with balloon dilatation was more safe for the treatment of larger choledocholithiasis.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.42

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